Wovon man nicht sprechen kann, darüber muß man schweigen.

An influential psychiatrist who was the host of the popular public
radio program "The Infinite Mind,"...earned at least $1.3 million from 2000 to 2007 giving marketing
lectures for drugmakers, income not mentioned on the program.

The psychiatrist in question is Fredrick Goodwin. As far as contemporary psychiatrists go, he is gigantic. He invented bipolar disorder. That's a joke, of course, by which I mean it isn't.

I.

He has a radio show? Are you listening, NPR? I want a radio show, too. (Disclosure: I get Pharma money. Is that going to be a problem?) If you hire me I'll stop making fun of you.

II.

But [the producer] said that he was unaware of Dr. Goodwin's
financial ties to drugmakers and that, after an article in the online
magazine Slate this year pointed out that guests on his program had
undisclosed affiliations with drugmakers, he called Dr. Goodwin "and
asked him point-blank if he was receiving funding from pharmaceutical
companies, directly or indirectly, and the answer was, 'No.' "

I'm not sure what to do with this. Is it possible the producer didn't know Goodwin got Pharma money? Who did he think paid for all that research?

Unless he's specifically worried about the lecture money he got; in which case the implication is that that money is magically more biasing then the grant money, or the government grant money. That would be, well, retarded, right?

III.

He said that he had never given marketing lectures for antidepressant medicines like Prozac, so he saw no conflict with a program he hosted in March titled "Prozac Nation: Revisited." which he introduced by saying, "As you will hear today, there is no credible scientific evidence linking antidepressants to violence or to suicide."

That same week, Dr. Goodwin earned around $20,000 from GlaxoSmithKline, which for years suppressed studies showing that its antidepressant, Paxil, increased suicidal behaviors.

I happen to agree with Goodwin that the data on suicide is tremendously weak. (But since I get Pharma money too, I'm biased...) However, he was never pushing antidepressants anyway; he didn't believe in them. Not because of flimsy evidence about suicide risk, but because of (even more flimsy) evidence of antidepressant induced mania (among other things.) For him and his devotees, it was mood stabilizers all the time.

But what's the controversy? He didn't ignore the data, he didn't hide it. If the money biased him he could have just kept quiet, never mentioned it. Instead, he took his views straight to the public; on the radio, for an hour. And, by the way, antidepressants shouldn't be used in the first place...

He wasn't biased because of Pharma money; he was biased because he believed it.

IV.

To illustrate this, imagine if, instead of debating the suicide risk of a drug for an hour on the radio for everyone to hear, he simply dismissed it-- even when he was one of the guys who discovered it:

...risk of suicide death was 2.7 times higher (95% confidence interval
[CI], 1.1-6.3; P =.03) during treatment with divalproex than during
treatment with lithium.

What would be even more amazing is if no one cared about him dismissing it.

He wrote that in 2003. 2.7 times higher? You would think that someone (i.e. him) would have made it priority #1 to explore that further. Nope. It is never mentioned again. Certainly not on the radio.

And you would have thought that the public, upset about him openly discussing for an hour on public radio the 2x risk with Effexor and Lexapro, would have been even more upset about not ever mentioning a 2.7x risk with Depakote. Also nope. We had to wait 5 years for the FDA to make a federal case about it.

He interpreted the results as lithium preventing suicide; but, as this is science, can you really afford to assume that?

Nobody cares because he didn't get Pharma money for this, so there was no outrage and an assumption that it couldn't have been biased. His career since the 70s has been lithium; no Pharma money there. Yet it was precisely his devotion to his research on lithium, to his career, which made him blind to his own discovery. It wasn't compatible with his worldview.

Maybe the finding is wrong; maybe the suicide increased because these drugs decrease REM sleep. Maybe a million things. 2.7x. Worth a mention?

Money corrupts; but it is always weaker than personal identity. Even though he was getting an extra $185k/yr from Pharma, which I assume is more than he was getting from his actual job as a researcher, he didn't think of himself as a Pharma lecturer, he thought of himself has a researcher on bipolar and mood stabilizers. That's who he is. That's the real bias, the one that counts; the one that makes him unable to see the very digits he types into a Word file.

And since there is no financial bias, we just eat it.

This is the same problem with Himmesltein's analysis of bankruptcies. When your data are screaming for alternative explanation, but you instead focus only on what you want them to say, everyone loses.

V.

That article was 11/08. It's now 7 months later. What has the outrage over Pharma money got us? He still gets paid for Pharma lectures. Psychiatrists still think of him as gigantic. I'm still neck deep in a field that thinks four drugs at a time makes sense. But he doesn't have a radio show. Problem solved?

If he didn't get Pharma money, would he have been able to afford the time to do a radio show?

I don't know how else to say this so that I'm not misinterpreted: if we persist in using money as a shortcut for critical interpretation, we are lost. And if we fail to appreciate insitutional biases-- "well, this is already established, no one seriously thinks otherwise"-- then we have already embraced despotism.

Addendum: Bill Lichtenstein, producer of the above radio show, comments.

Comments

There is another issue here as well. Assuming the guy from NPR isn’t lying to cover his ass, Dr. Goodwin’s lectures were not marketing lectures in Dr. Goodwin’s eyes, but apparently in NPR's and the NYT's they were. Once upon a time, the public (and NPR/NYT) would take the doctor's word over what constituted a professional activity, as opposed to a marketing activity. Now, they feel as though they are able to make that distinction in contradiction to Dr. Goodwin's claim that he didn't make money from marketing. If you believe the guy from NPR. Of course NPR could just also be lying to cover its ass, assuming that if the NYT says it is marketing it must be marketing. Once again, don’t believe the doctor.
So, I’m sure that Dr. Goodwin really just thought he wasn’t marketing anything ever, just being paid to say what he already thought reflecting how he practiced.
I’m also sure NPR tossed him to appease their listeners who seem to view the NYT’s reporting as sacred… least NPR get less donations.

I'm curious. Is there a "humanity" bias ingrained into all humans? If so, how would we define this bias? Is it the bias to preserve the species or to preserve your genetic interpretation of the species?

To this end, would constructing elaborate businesses, value-chains and molecules designed to help humans live longer, happier lives, run counter to the self-preservation bias that allows us to retain industrial secrets, or is it just an extension of the self-preservation bias insomuch as people now have to pay for your product that saves their lives? To this end, is religion still the cheapest form of psychiatry?

First off, the production of the radio show was ended months before the NYT story and for reasons that had nothing to do with any conflict of interest. What may have been dropped was re-runs, and that is up to local NPR affiliates.

Second, the producer was obviously lying about non-disclosure. A former associate producer of the show confirmed so in a NYT letter-to-the-editor. The show was significantly funded through grants from major drug companies. The producer would have been depositing the checks. The question would never even need to be asked because the answer was so obvious. But the producer is responsible for including such things on a show for the host and guests. There may also have been some liability issues for the producer.

As you point out, the controversy is manufactured. There was no attempt to show bias, just the possible perception of bias. Is there any doctor or researcher in any medical field who's worth listing to that doesn't receive money in some from from some drug or device manufacturer? Would anyone consider not getting treated by a doctor with such a perceived bias?

I wrote about this a couple of months ago. What disturbed me was not the conflict of interest but all the false statments made on the show. No one at NPR seems to care at all about the accuracy of the show. I thought I made a pretty good suggestion at the end of the piece, but I also realize that NPR could never accept it. My posting is at:

Thanks for the link to your factual, insightful article. It's a relief to read "fact-driven" as opposed to "feeling-driven" commentary on these kinds of subjects. Personally, I'd like to see a little more fact checking on this site- like yours and "G's."

A few more facts that seem to elude this diarist are:

1. There is a greater incentive to "cook the books" when it comes to monetizing results. I'm afraid someone will have to show me the data on government studies not funded by Pharma which show exactly the same kinds of experimental design, data manipulation and publishing bias, to the same extent, that the industry excels in producing.
2. Has anyone not heard of the concept of full disclosure? Let individuals make up their minds whether or not it's relevant who has what connections and who's on whose payroll. Full wouldn't just mean "former FDA official," it'd also mean currently "employed by a PR firm which represents Eli Lilly, Glaxo SmithKline, and Pfizer- in other words, the major antidepressant manufacturers." h/t to Leo.
3. With programs like this: research as "caveat emptor." Take any study at face value, listen to any "expert's" monologue as definitive without doing the "math" and risk these sorts of debacles.

My argument isn't with Goodwin- it's with using him as a straw man to somehow disregard the very real influence money plays in how research is conducted, what research is conducted, how results are measured and how data is either published or buried. This is not indulging in a "shortcut," this is acknowledging the reality of human behavior.

I just read your post about Fred Goodwin and the public radio program that my company produced, The Infinite Mind, with interest.

You highlighted numerous, valid issues about the problems created by the acceptance of pharmaceutical funding by medical researchers and now journalists, in the case of Goodwin.

However, you raised several points and questions that have been addressed and answered over the past eight months since the Goodwin story was first reported. They include:

1) With regard to Fred Goodwin's acceptance of pharmaceutical funding, we at The Infinite Mind were not aware at any time of his receiving fees for giving pharmaceutical marketing talks, and our understanding from Goodwin, as is reflected in his professional curriculum vitae and elsewhere, was that the last research he published that was funded by the pharmaceutical industry was in 2001.

2) The Infinite Mind's signed contract with Goodwin expressly prohibited his doing anything that would present a conflict of interest with his role as host of the public radio program, without notifying his producers (see copy of signed contract at www.lcmedia.com/agreement.pdf).

The fact is that Goodwin's agreement, which he signed in 2006, was the subject of lengthy negotiations, and at the time Goodwin signed it, he was required to declare any past conflicts (going back to 1997), or any conflicts that might arise in the future. However, he failed to do so, including with regard to the hundreds of thousands of dollars he was receiving from GlaxoSmithKline at the very same time that he signed the 2006 agreement. Furthermore, in mid-2008 I asked him point blank if he was receiving any funding from pharmaceutical companies, and he said "no."

3) Goodwin's assertion that The Infinite Mind, its producers, and I in particular, were aware of the more than $1 million in undisclosed fees he received to give marketing talks for pharmaceutical companies has been completely debunked, and to date Goodwin has failed to produce a shred of evidence of any kind to indicate that we were aware of his activities.

The only indication that we knew of Goodwin’s speaking fees was an NPR "On The Media" report, based on the word of an anonymous source, which alleged that we were aware of Goodwin’s being paid to give marketing talks for GlaxoSmithKline. However, as you may be aware, “On The Media” just issued a formal retraction and apology for the report, after the anonymous source came forward to say the radio program had misrepresented what she told them, and that she had no evidence that we were aware of Goodwin’s speaking fees.

Meanwhile, Goodwin's position with regard to The Infinite Mind and his conflict of interest has continued to evolve since the November disclosure. He has denied to the “GW Hatchet” (the student newspaper at George Washington University where Goodwin teaches) that there had been a conflict, and essentially proposed a novel concept of conflict of interest: “I frankly do not see these things as a conflict of interest. It was my judgment,” said Goodwin. “Like most experts in my field, I have relationships as a consultant with a number of pharmaceutical companies. I’ve always thought that if you have multiple relationships they sort of cancel each other out.” More recently, Goodwin has denied there could have been a conflict of interest since he “didn’t have final editorial control of the program.”

4) I agree with the rest of what you say: even if there was no demonstrated connection between the funding Goodwin received and what he said on the air, conflict of interest is a very subtle and insidious thing, and it's impossible to know what the impact was of the $1 million he received, even though the vast majority of the programs on The Infinite Mind had nothing to do with mental health treatment or medication. The problem of undisclosed acceptance of pharmaceutical fees is a troubling situation in academia and medicine, and now unfortunately, it has spilled over into journalism.

Best,

Bill Lichtenstein

(Alone's addendum: Bill Lichtenstein was the producer of The Infinite Mind Radio program)

As much as I hate the pharmaceutical companies for their "me too" drugs that helped maintain Psychiatry in its frozen state for over five decades, I hate the university researchers even more for their academic chutzpah that masquerades as cutting edge science. Not even Alone paid enough attention to the single most important bias issue that enabled this gang to continue justifying their existence at the expense of younger researchers who could have transformed my field: The peer review of grant applications to the NIMH. Each year, hundreds of millions of dollars are distributed among the likes of Goodwin (we have ~10-15 people like him who determine what is going to be investigated within the next five years by funding each others' studies). It is a secretive process that is influenced by a humongous amount of bias that cannot be detected as easily as how much Astra Zeneca pays Alone. Try calculating the likelihood of Professor X's approving of Professor Y's protege's K01 application based on Y's approval rate of X's research article submissions to his journal. Good luck finding that in the disclosure section.

I know I'm defending the guy I've repeatedly said his obsession with narcissism is off the charts, unsound, and may be due to an ongoing midlife crisis (though in academic years he'd still be called junior, to be precise), but he has repeatedly stated how much Academia's farty pants quest to be recognized and how government funding are just as bad (or, by stating this one could be stating the opposite, it isn't necessarily bad or "as bad") as private funding and private research's own bias. There's plenty of bias in the field. Look at his posts, if anything, he's nailed this one.

1 It is curriculum vitae, not vita with vitae being the genitive of vita.
2 "...about not ever mentioning a 2.7x risk with Depakote". It doesn't follow from the quoted study that Depakote is actually increasing the risk. You can argue that it lowers the risk to a lesser degree then Lithium does, but you need a different study design in order to make a quoted statement.

1) If you can't get to your supply or the supply is too expensive for you and you have withdrawal effects is one reason. Slave to supplier/doctor/pusher.
2 a) would be the drug causes cancer/disease/too much physical damage for the body to heal from on a daily basis.
2 b) would be cumulative brain damage from its consumption , growing incompetence can not be perceived by the incompetent. example of Meth or Crack addict.

In response to G: "Is there any doctor or researcher in any medical field who's worth listing to that doesn't receive money in some from from some drug or device manufacturer?"

God, I sure hope so. I sure hope there are some fair-minded physicians and/or researchers who aren't feeding at the trough of pharma. (I like to think that I'm one of them.)

Your ignorant attitude (shared by many, I'm sure) implies that only intelligent physician-scientists get money from drug companies and that those who don't bring in cash (or who are "stuck" in private practice, smaller academic departments, etc) have opinions that aren't worth listening to. Which keeps the cycle going and going and going....

I read this with great interest, but can't help thinking...as a patient with bipolar II (educated, graduate degree, 140+ IQ in three full-day neuropsych batteries), who through six years since diagnosis has been on ~20 drug combos and still unstable, consulted with a top psychiatrist in NYC, top memory and mood clinics (thank dog for good insurance)...seen some mildly troubling things with my psychiatrist, e.g., gets taken out for very expensive dinners by the drug reps, LOVES Lamictal, which didn't end up working for me after a 4+-year trial...where does this leave me? In bed with Pharma or no, what do I do at this point? I feel like I've run out of options and even ECT has been ruled out. Any innovative ideas as to What Do I Do Next? My ire is up at this story, but what good does this do for a patient in the trenches...? Thanks LP.

TLP has it right. It's the normative psychiatric Weltanschauung, that really matters. The problem with psychiatry is the institutional inertia maintained by the same dysfunctions that maintain our rotten political system, ego, indolence and greed. Any one will do.

Peter Kramer built an entire professional edifice around psycho-pharmaceuticals as benign psycho-cosmetic surgery with Listening to Prozac. He is blinded to the limitations of psycho-drugs by his own ego. Kramer doesn't need Big Pharma money to augment his Olympian view of himself. And he has plenty of ego driven pals in the business who think the same way.

Ultimately you are in control of your own treatment. We patients sometimes "forget" this and rely upon authority figures despite conflicting evidence.

I'm curious:

1. If you were unconfortable with your pdoc's relationship with pharma marketing reps why did you continue treatment with him? Not that this is necessarily an unwise decision, but blind deference to authority can prevent us from acting in our own best interests, IMHO.

2. Re: Lamictal, I'm wondering why you would continue with a treatment for that long if it wasn't working for you.

If were me, I would have found a new pdoc long ago if only because he ignored my insistence that I was not improving. Sometimes we don't get better at all. But we don't know what other options are available to us if we continue to rely upon only one possible interpretation.

What I suspect in some cases is that we patients use our pdoc's advice/action/inaction-whatever-as an excuse for avoiding our own responsibilities. It seems to me it can make it convenient to avoid the hard work of getting better.

While there are legitimate criticisms, we ought not use them as excuses if we are capable of taking alternative action.

These are just my own observations. I have no idea at all if they apply to anyone else.